Prise en compte de l’entourage des patients atteints de cancer: un aperçu mondial des programmes et des actions d’information et de soutien

Résumé: Une étude bibliographique sur les publications concernant la prise en compte de l’entourage des patients, montre que ce sont les pays scandinaves et anglosaxons qui ont le plus avancé dans cette réflexion et dans la mise en place de programmes évalués destinés à apporter soutien, conseils et aide aux proches de malades atteints de cancer. L’entourage concerne les proches, c’est-à-dire la famille et les amis, et dans certains cas, l’équipe soignante. Il s’agit d’une vision très large dans le cadre d’une prise en charge globale.Nous assistons en France depuis les premiers États Généraux des malades du cancer organisés par La Ligue Nationale contre le Cancer en 1998 et en 2000 à une évolution irréversible des mentalités qui ne peut que déboucher, grâce aussi au Plan Cancer, à un meilleur soutien non seulement des patients mais encore de leur entourage.J.-M. Dilhuydy, Groupe Réinsertion de la Fédération des Centres de Lutte Contre le CancerNous tenons à remercier particulièrement la Ligue Nationale contre le Cancer qui, par son soutien financier, a permis la réalisation de ce travail.     

Thérapies familiales et maladies mentales complexes

If complex mental diseases are affecting not only persons who present troubles, but also their close relatives, the way to proceed needs new and specific family interventions in a therapeutic purpose. Most often the demand comes from the professionals involved in the care. They have to deal with the reduction of individual and family autonomy. The first step is to delimit the fields of shared helplessness, in a way to enhance the therapeutic potentialities, which appear at the boundaries of these fields and which appeal to the life ecosystem's resources. Then the focus of the therapy is today life-axis than history, prospective rather than retrospective. The purposes are to help and hold the family members, to relieve their sufferings, to reduce their anxieties, to offer a space of humanity, of conversation, of elaboration about what happens, of emotional and cognitive sharing.     

Le travail des centres maternels auprès de jeunes mères célibataires à haut risque

Single mothers represent about a quarter of French single-parent families. Within the population of single mothers, those who seek shelter in institutions such as maternity homes constitute a high-risk group. Grounded on two field studies with this population, and on our own clinical experience of joint psychotherapy of these mothers and their infant, this paper discusses the complex work realized by maternity homes. It emerges that maternity homes, as institutions, are brought to play, on the one hand, a maternal role that includes the holding, a “protective shield” role against excitation, and the safety of the mother to be and her infant. In this protected and stable environment, the mother will be able to develop her competencies to raise her infant and to build an affective bond with him. On the other hand, maternity homes should also act as a “father”, mediating the mother-infant relationship and, in doing that, they have to engage, as much as possible, the infant's father himself. In this “paternal role”, the institution should open the mother and her infant to the outside world, (re)integrating them in a social and affective network, and preventing them to relapse into the isolation or the multiple deprivations experienced by the preceding generations.     

Gender dysphoria and homosexuality: A patient series

PurposeTo present the clinical course of adolescents who presented to the child and adolescent psychiatry outpatient clinic due to gender dysphoria and homosexuality through a patient series.MethodsThe clinical features, comorbidities, and the treatment process of 10 patients who presented to the outpatient clinic and were followed up over a period were presented.ResultsThe average age of the 10 patients, 5 girls and 5 boys, was 14.3 years for the girls and 16 years for the boys. Nine patients were admitted by their families primarily with the desire for the elimination of gender dysphoria or homosexual orientation. Only one female patient was brought by her family because of her intense depressive symptoms and suicidal thoughts. All of the patients had comorbid psychiatric diseases, nine had depression, and one had bipolar affective disorder comorbidity. The anxiety levels of all patients were high. Psychiatric management in each patient focused on the emotional, cognitive and social difficulties of the case. The treatment of two girls was interrupted suddenly by the family because they saw that the homosexual orientation of the patients was continuing. Two male patients were not brought back for treatment after the evaluation process.ConclusionsGender dysphoria and homosexual orientation are situations that families still find it difficult to accept and that they think it can be eliminated by pressure, coercion or psychiatric treatment. Patients show a high rate of psychiatric comorbidity due to family pressure and social exclusion. Although psychiatric support can cure comorbid disorders in a relatively short time, strains of family and social relationships continue to affect patients.     

Faire fratrie : réflexions autour du lien fraternel

Background

In its most simple definition, the dictionary points out that sibling is “all the brothers and sisters of a family”. Brothers and sisters are persons having family ties, usually children descended from the same couple, or with only one parent in common, or bound by adoption.

Methods

From the observation of several siblings who lived through a separation, we offer a reflection on the meaning of siblings. We present two clinical vignettes to illustrate this reflection. The first case is a seven year-old child, placed in a foster care family, who built his brotherly identity in relation to this family and not to his biological family. Contacts with his biological parents and siblings are offered to him, but it is the feeling of belonging to the foster care family that makes sense to him. Secondly, we present, through the therapeutic coverage of a 21 year-old woman, formerly adopted, the fantasmatic stake of the brotherly in her psychic elaboration. She is an only daughter in her family, but she elaborates her psychic identity in reference to a fantasmatic space made of brotherly representation in relation to a hypothetical biological sibling.

Results

These illustrations bring to light the fact that sibling is not only a notion ensuing from the emotional bonds woven between its members. It is neither necessarily a matter of blood ties, but also, we realize how thinking out sibling and brotherhood creates a psychic space, necessary to any individual, in order to think of himself as a member of society. This second dimension is mainly born by the parents’ desire, which they express in front of their child. It is, indeed, because the parents wish to pass on and give a meaning to sibling that the children will be able to develop brotherly bonds.

Perspective

The brotherly group defines brothers and sisters as those who were raised together. This definition is not a demographic nor a biological one, but definitely a psychological one. As a conclusion, we emphasize that, in a situation of separation of the biological siblings, due to placement in a foster care family or an adoption, it is necessary to talk within the family about sibling in its biological and psychological reality, so the “making of sibling” can be elaborated serenely.     

Passage à l’acte familicide et filicide : deux réalités distinctes ?

The objective of this study is to compare men who killed their wives and at least one of their children (familicide) with men who exclusively killed one or more of their children (filicide), using socio-demographic, criminological, situational and psychological-psychiatric variables. The data was obtained from the Coroner’s files in Québec for the period of 1986 to 1998. A total of 16 men who committed familicide were compared with 36 men who committed filicide. The results of the analyses indicate that there are significant differences between the two groups of men. Men who committed familicide are older, are more often born out of Canada and more often use a firearm as well as overkill while committing the offence in comparison to men who committed filicide. These men are also more often in the process of a conjugal separation, they have more often experienced losses (i.e. job loss, etc.) and they show more symptoms of depression in the year prior to the homicide, compared to filicidal men. Based on these results, the individuals who committed familicide exhibit a different dynamic than those individuals who committed filicide. These results have an important impact on the treatment of these individuals as well as on prevention.     

Psychosomatique de l’eczéma chez l’enfant : une problématique d’indifférenciation au sein du groupe familial

Our research consisted in evaluating the interference of the image family body in families concerned by dermatitis helped by a new projective tool: the family drawing of the dream house. We compared 28 drawings from children stuck down by eczema to 28 drawings from general population. Our results show a significative diminution of individuals’ spaces and a research of intimity, which reveals a family representation of a common body. This body prevails to the detriment of individuals building their seilf-sufficiency. The identity landmarks, less clear, would explain the identity troubles found in those cases and eczema would be the symptom.     

De l’enfance à l’âge adulte : quelques effets d’un environnement postmoderne sur le processus de subjectivation

Postmodern world offers to children and to teenagers a new environment. The couple is make casual, and the families often multi-recomposed. Care-taking and education of children and teenagers are profoundly modified with the estompage of the big structuring marks of the difference of genders and that of the generations, the shrinkage of authority in education. Some families have given up education of their child as preparation for the grown-up life. There is a loss of the complicity between parents and school. The invasion of cultural and family world by screens adds a deep novelty in the exchanges of the young person with its environment, in particular by the interactivity and the opening without limit to the virtual world and the absence of real parental control. The construction of the personality of the child as that of the teenager in its architecture as in the balance between the various classic instances are modified there. What are the effects of these changes during the transition to adulthood, on the process of subjectivation so essential for adolescent process? Does-it ensue from it one organisation modified by the personality?